Cost Plus analyses

The listing standard

A direct-contract network is only as strong as the bar to get into it. Cost Plus Wellness publishes the contracts; last week we published the record behind them. This is the standard those records should meet, built only from the federal file. Every published provider we screened clears it.

·Three requirements to list, all from the public federal record: clean exclusion screen, no license discipline, quality reported to CMS.
·The quality score is disclosed for every provider, against the CMS threshold of 75.
·Independent analysis. Not affiliated with Cost Plus Wellness.

The standard

Publishing a contract is not the same as vouching for the provider. A stated bar, checked against the federal record, is. These are the three requirements a provider clears to be listed, and the quality score we disclose beside them.

Requirement 1

Clean exclusion screen

Every clinician on the group's roster is screened against the OIG federal exclusion list and state exclusion lists. The bar is zero active exclusions.

An excluded provider cannot be paid by federal health programs. Listing one is a direct compliance and payment risk for a self-funded employer.

OIG LEIE + state exclusion lists · re-screened 2026-09-30
Requirement 2

No license discipline

License status and disciplinary history come from state boards. The bar is no disciplinary action found against a screened clinician.

Disciplinary history is the clearest public signal of a provider an employer should not steer members toward.

State medical and professional boards
Requirement 3

Quality on the public record

The group reports quality measures to CMS through MIPS. The bar is that it reports at all, so its quality can be checked, and where the group is large enough to score, the median meets the CMS threshold.

A provider that reports nothing cannot be verified. A network that lists unmeasured providers cannot answer the quality question.

CMS Quality Payment Program (MIPS)
Disclosed for every provider

The quality score

Where enough clinicians report to compute a reliable median, we show it against the CMS performance threshold of 75, below which CMS applies a payment penalty. Where too few report, we say so and claim no level.

CMS Quality Payment Program · median MIPS score, 0 to 100

The published providers, against the standard

The same ten providers from last week's scorecard, each measured against the three requirements. All ten clear it.

Provider No exclusion No discipline Reports quality MIPS median Meets standard
Texas OncologyOncology · TX✓✓✓85.1Listed
HeartPlaceCardiology · TX✓✓✓86.4Listed
Urology Clinics of North TexasUrology · TX✓✓✓90.1Listed
Dallas Nephrology AssociatesNephrology · TX✓✓✓too few to scoreListed
North Texas Center for RheumatologyRheumatology · TX✓✓✓too few to scoreListed
EmergeOrthoOrthopedics · NC✓✓✓89.1Listed
Watauga OrthopaedicsOrthopedic Surgery · TN✓✓✓85.3Listed
First Settlement Physical TherapyMulti-specialty · WV✓✓✓87.4Listed
The Iowa ClinicMulti-specialty · IA✓✓✓100.0Listed
Tellica ImagingImaging · UT✓✓✓too few to scoreListed
"No exclusion" and "No discipline" are checked across the group's full roster. "MIPS median" is shown where enough clinicians report to compute one; where fewer than ten report, it reads "too few to score." All shown medians are at or above the CMS threshold of 75.

Why a standard, not a report

A network is judged by who it lets in. The common criticism of direct-contract networks is that they carry no quality data. The answer to that is not a one-time report. It is a bar the network runs on, checked continuously.

Data you publish is copyable. A standard you keep is not. A report is a snapshot; a listing rule is how a network stays clean as it grows, because a provider that later picks up an exclusion or a license action no longer clears the bar.

This standard uses only public federal records, so anyone can reproduce it, and we publish the limits with it: the license check reads a sample of up to thirty clinicians per group, and small groups do not report enough to CMS to score a reliable median. We show that rather than smooth it.

The same ten, measured deeper

Tell us what else you want from this list

These are the same ten providers from last week's scorecard, now held to one bar. The federal record carries more than this page shows. For any of these groups, or one you name, we can add:

  • Procedure volume as a safety signal: how much of a procedure a group actually does, from Medicare utilization.
  • The quality trend: the MIPS score across years, not a single snapshot.
  • The MIPS breakdown: the quality, cost, and interoperability scores behind the one composite number.
  • For surgery centers: patient-experience scores and the safety measures, including patient burns, falls, wrong-site procedures, and post-op hospital transfers.
Tell us the metric or the group: adrian.ruiz@verzihealth.com

Method

  • Exclusions: every clinician NPI on the group roster screened against the OIG federal exclusion list (LEIE) and state exclusion lists; re-screened 2026-09-30.
  • Discipline and licenses: license status and disciplinary history from state boards, on a sample of up to thirty clinicians per group.
  • Quality: CMS Merit-based Incentive Payment System (MIPS) final score per clinician, 0 to 100. The median is shown where at least ten clinicians report; the CMS performance threshold is 75.
  • Absence of a finding is stated as "none found," not as proof. Small samples are shown as such.